SINGAPORE — Regular handwashing is an important part of personal hygiene. But what would you do if your child takes this everyday routine to the extreme?

Miss Anastasia Zhai was only 13 years old when she was diagnosed with obsessive compulsive disorder (OCD) two years ago. She would wash and scrub her hands every 20 minutes, not stopping even when her skin cracked and bled from the obsessive handwashing.

For Anastasia’s mother, Madam Faye Tan, it was the start of a two-year-long parenting nightmare.

Once cheerful and bubbly, the 46-year-old working mother’s daughter had become withdrawn and moody, often hiding in a corner of her room. She would also draw circles on paper repetitively.

“I’ll always remember that dark period in our lives. The whole thing occurred out of the blue and she became a totally different person,” said Mdm Tan.

One of the top three most common mental-health disorders in Singapore, OCD is a type of anxiety disorder characterised by obsessive and compulsive thoughts and behaviours.

About one in 33 adults in Singapore has had OCD at some point in his or her lifetime, based on a Singapore Mental Health Study conducted in 2010. The Institute of Mental Health’s (IMH) outpatient clinics see some 600 to 700 adults with the condition yearly.

WHEN OCD STRIKES IN CHILDHOOD

Children and teens are not spared from this mental-health disorder, which causes problems in the way the brain processes information.

The IMH Child Guidance Clinic runs an OCD programme for children and teens up to 19 years old with moderate to severe forms of the disorder. It sees between 100 and 200 children and teens with OCD each year. The youngest patient on the programme is nine years old.

The figure may represent only the tip of the iceberg. Identifying young OCD sufferers is challenging, as young people are often secretive and ashamed of their symptoms, said Dr Adrian Loh, visiting consultant at the IMH’s Department of Child and AdolescentPsychiatry.

When OCD strikes in childhood, it can be a mind-boggling experience for both the child and parents.

For one, children and teens are not as well equipped as adults to understand that their obsessive, compulsive symptoms are abnormal.

Ms Haanusia Prithivi Raj, senior clinical psychologist at the Department of Child and Adolescent Psychiatry at the IMH, stressed that it is important for parents to understand that their child’s OCD is not a result of a “weak” or unstable personality. Neither is the child deliberately misbehaving. A person with OCD has obsessive thoughts, worries or urges that are intrusive and may not always make much sense, said Ms Haanusia. To ease anxiety, the person may engage in repetitive actions called compulsions.

In young patients such as Anastasia, the symptoms often present themselves in the form of compulsive behaviour, such as touching certain objects in a specific manner or having to say things in a certain way without understanding why they do it, said Dr Loh.

He added: “In many of these cases, they may say that (their compulsive behaviour) ‘feels right’, which leads to much parental frustration.”

What exactly causes OCD in children is not known, but certain risk factors such as an anxious temperament and a family history may increase the risk of developing OCD. Ms Haanusia said research also suggests that OCD is linked to insufficient levels of the brain chemical serotonin.

As Anastasia’s symptoms worsened, getting her to attend school and doctor’s appointments became a struggle.

“It reached a point where she didn’t want to talk or look at me and her younger brother. She constantly looked down at the ground. I couldn’t understand why she was doing that and I felt so helpless,” said Mdm Tan.

EARLY TREATMENT, BETTER OUTCOMES

The turning point came when she voluntarily agreed to be admitted to the IMH’s child ward. Warded for three months, her condition gradually improved with the right treatment.

The diagnosis and timely treatment was a relief to her mother. “At least, there is a name to her illness. If there’s a diagnosis, there is a chance of recovery with professional help,” said Mdm Tan.

The sooner OCD is tackled, the better treatment outcomes are likely to be, said Ms Haanusia.

The first line of treatment for mild to moderate OCD is the use of cognitive behavioural therapy (CBT), which may span up to 14 sessions over a three-month period, said Dr Loh. It incorporates the use of a technique known as Exposure and Response Prevention, in which the patient is deliberately exposed to upsetting OCD triggers.

This works on the principle that anxiety towards the upsetting triggers will gradually reduce if the OCD sufferer is given sufficient contact with those triggers, explained Dr Loh.

In addition to CBT, medication is considered when a child’s OCD is in the moderate to severe range.

Anastasia’s treatment involved a combination of medication and behavioural therapy, which has been found to significantly reduce OCD symptoms in severe cases.

Another factor that had played a huge part in her road to remission was her family’s unwavering support. From sitting in one corner of the ward, she had gradually warmed up and interacted with her uncle, aunt and grandma when they visited.

Her mother continued to visit her every day, even though she would not look at or talk to her.

“I had to sit on the other side of the ward, away from her. Even when she was well enough to be discharged, she was still not talking or making eye contact with me. I don’t blame her because I know it’s all part of her illness,” said Mdm Tan.

Now at age 15, Anastasia is considered to be in remission. Currently still on medication, she is almost back to her old cheerful self, although she still has some quirks, such as arranging her personal belongings in a certain manner.

“Now, we can have a meal and watch movies together. It’s such a miracle; it feels like my daughter has finally come back to me again. My advice to parents who have children with OCD is (to) never lose hope and (to) seek professional help.”

Talk on understanding OCD in kids and teenagers

Dr Adrian Loh and Ms Haanusia Prithivi Raj will be sharing their expert views on obsessive compulsive disorder (OCD) in children and teens in a talk organised by the Institute of Mental Health.